Transforming Healthcare via Continuous Performance Improvement (CPI)

CPI Doctor 2Seattle Children's Hospital is one of the first medical centers in the country to apply the methods and scientific rigor of the Toyota Production System to healthcare. Seattle Children's adaptation of this method is an organization-wide philosophy and improvement approach called Continuous Performance Improvement (CPI).

This improvement program is a transformative way to remove waste from systems and processes, thereby improving quality and safety to deliver the best healthcare to patients and families. Importantly, when we improve quality and safety, we reduce costs. Seattle Children's is dedicated to making ongoing improvements to the basic building blocks of healthcare: Quality, Safety, Delivery, Cost and Engagement.

Over the last decade, adoption of CPI with active involvement of our expert caregivers has yielded tremendous results. Through CPI, physicians, nurses, residents, administrators and hospital staff are actively engaged in a culture of continuous performance improvement. CPI allows us to evaluate and improve healthcare from a patient and family perspective, better support our people, adopt new practices and respond to economic challenges. It is also proving to be a reliable means to advance core clinical, education and research programs. Ultimately, this work helps support our ambitious mission to provide hope, care and cures to help every child live the healthiest and most fulfilling life possible. In summary, CPI has been transformative at Seattle Children's, and we believe it can transform our national health care system as well.

Key Aspects of CPI

  • It's about putting patients and families first – we view the uniqueness of our patients as our only variation in applying consistent, reliable methods in delivery of our services. To view examples of this work, please visit our Clinical Standard Work page.
  • Reducing costs is a by-product of improved safety, quality and outcomes – we know that if we focus on better care first, cost savings will follow.
  • Empowering and engaging employees is key – we seek to transform our culture by empowering our physicians, nurses and employees with the tools they need and removing barriers allowing them to identify and eliminate waste and spend more time with patients.
  • Taking the long-term view – CPI is an ongoing, iterative process that is continuous. It is not a short-term, "flavor-of-the-month," cost-cutting program.

Results Achieved

  • Patients remained on ventilators 20% fewer days
  • Total parenteral nutrition (TPN) medication error rates were reduced by 66%
  • Patient time in hospital was reduced from 20 to 10 days in the Inpatient Psychiatric Unit (can now accommodate 650 children vs. 400 a year)
  • Patients spent 20% fewer days in the Intensive Care Unit
  • Patients see doctors sooner: appointment scheduling times dropped 50%
  • Fewer Emergency Department patients leave without being seen at peak times (achieving a 0.7% rate, compared to a 2.4% national rate)


  • 3.7% reduction in cost per patient, resulting in $23 million in annualized savings*
  • 30,000-square-foot space reduction in design and construction of new ambulatory services clinic, achieving $20 million cost avoidance
  • $180 million in capital cost avoidance by not building new patient rooms
  • $2.5 million reduction in supply-related costs

* Adjusted for inflation

CPI in the News

Seattle Children's CPI approach is receiving interest from healthcare peers, policymakers and the public from around the country. Seattle Children's is committed to sharing advances about ways to remove waste from healthcare and inform the healthcare-reform process. Here are a few examples of our recent national media coverage on CPI:

The New York Times

New York Times reporter Julie Weed visited Seattle Children's to observe how we apply CPI methods, and talked with our physicians, nurses and administrators. Read her July 2010 story, Factory Efficiency Comes to the Hospital.

The Washington Post

In October 2009, The Washington Post published a guest opinion piece about applying CPI in healthcare by Pat Hagan, Seattle Children's then–president and COO. Read Waste Not, Want Not: The Key to Reducing Costs.

JWA Consulting

Seattle Children's has a longtime partner in our CPI efforts, JWA Consulting. CPI experts from JWA have been constant collaborators in our quest to implement Continuous Performance Improvement and to support transforming our staff, practices and culture.